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NPI Code Detail

MEDICARE: DR. DANIEL CURTIS CALLSTROM D.D.S.

MEDICARE: DR. DANIEL CURTIS CALLSTROM D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD11112MN

General Provider Information

NPI Number : 1356343230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL CURTIS CALLSTROM D.D.S.
Provider Business Mailing Address
First Line : 114 3RD ST N
Second Line :
City : CANNON FALLS
State : MN
Zip : 55009-2011
Country : US
Telephone Number : 507-263-4501
Fax Number : 507-263-5691
Provider Business Practice Location Address
First Line : 114 3RD ST N
Second Line :
City : CANNON FALLS
State : MN
Zip : 55009-2011
Country : US
Telephone Number : 507-263-4501
Fax Number : 507-263-5691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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